What is the social impact of ADHD?
ADHD can have a significant social impact on affected individuals’ lives, causing disruption at school,1-3 work1,4-7 and in relationships.2,4,8,9 Symptoms of ADHD may also be associated with increased risk-taking behaviour.1,10,11
The impact of ADHD on education
The hyperactive, impulsive and inattentive symptoms of ADHD may negatively impact functioning and behaviour of children and adolescents with ADHD in the school setting.12 A large, cross-sectional, European Lifetime Impairment Survey (sponsored by Shire, now part of Takeda) assessed parent-reported impairment and symptoms of ADHD in children and adolescents (n=535) compared with children and adolescents without ADHD (n=424). Their findings indicated that more parents of children with ADHD, compared to those of children without ADHD, tended to report impairments for their child at school, such as2:
- Becoming easily frustrated and distracted
- Acting in ways others see as inappropriate in social situations
- Difficulty following instructions
- Failing to meet deadlines for assignments
- Making careless errors in homework.
There is also research to suggest that some adults with ADHD may have had disrupted education in earlier life. It has been found that adolescents and adults with ADHD are less likely to have graduated from high school or have achieved a college degree.1 Potential reasons for this included the inability to handle large workloads, inattention, disorganisation, difficulty following instructions and making careless errors.1
The impact of ADHD on employment
Some adults with ADHD have been found to have occupational difficulties that may affect their productivity in the workplace and their reputation as an employee, with high job turnover and unemployment frequently observed.1,4-6,13 Additionally:
- Some adults with ADHD may be sporadic and disorganised in their job searches.13
- ADHD symptoms may hamper some forms of employment, with difficulties in time management and impaired social skills, perhaps meaning that adults with ADHD find it difficult to retain a job.13
- On the other hand, some forms of employment may be well suited to adults with ADHD, particularly more creative or active jobs.13
- Some adjustments that could be made in the workplace to accommodate adults with ADHD include the option of working in a private space to reduce distraction or the use of incentives for task completion as encouragement.13
The impact of ADHD on family and relationships
Symptoms of ADHD can negatively affect family life and relationships. ADHD may affect the relationship between children and adolescents with their parents or carers.2 An Australian study reported poorer family functioning in children (aged 6–9 years) with ADHD (n=30), compared with children without ADHD (n=156). The outcome variables negatively affected by ADHD included family quality of life (emotional impact and family activities), parental psychopathology (depression, anxiety and stress), parental warmth, consistency of parenting and parental hostility.8
Some adults with ADHD may have difficulty in maintaining relationships with the people around them. They may experience irritability, inattention, impulsive talking and forgetfulness which can contribute to misunderstandings in social interactions.4 Impairments in partner relationships and social functioning have been reported to be associated with adult ADHD.9
ADHD and problematic risk-taking behaviour
A study of 5–10-year-old children (ADHD group, n=103; non-ADHD group, n=100) showed a significant correlation (p<0.001) between symptoms of ADHD and greater risk-taking and reduced sensitivity to punishment.10 However, a Norwegian study suggested that children with ADHD are not particularly risk-prone, but may not respond well to changing probabilities of success in a given task. When compared with an age-matched control group of children without ADHD (n=34), children with ADHD (n=36) showed significantly poorer risk-adjustment (p<0.01) and significantly more delay-aversion (p<0.01) during the Cambridge Gambling Task; however, reflection time and risk-proneness did not differ between the two groups.11
Symptoms of ADHD, such as impulsivity and increased risk-taking behaviour,12 may lead to adults breaking societal rules and norms.
Research has found that symptoms of ADHD in adults were associated with a higher incidence or risk of the following compared with people without ADHD:
- Criminality and arrests1,14
- Substance abuse4
- Aggressive/reckless driving4
- Traffic violations14
- Suspension of driving licence14
- Crash risk.15
What is the impact of ADHD on quality of life?
Evidence suggests that ADHD may reduce the quality of life of children, adolescents and adults.2,16-18 However, some positive aspects of ADHD have been reported.4,19 For example, a qualitative study of eight individuals diagnosed with ADHD (aged 21–50 years) reported improved functional abilities in areas including interpersonal skills, motivation, organisation and concentration span as a result of their ADHD.20
A large, cross-sectional, European Lifetime Impairment Survey (sponsored by Shire, now part of Takeda) in children and adolescents with ADHD found that ADHD had a strong or moderate effect on different aspects of daily life as reported by parents/carers (n=535), including life at school, daily life and activities, social life, life at home and relationships.2 Assessing the impact of ADHD in childhood and adolescence retrospectively revealed that fewer adults with ADHD (n=588) agreed with statements such as “I was popular outside of school” and “I had good relationships with my siblings” than adults without ADHD (n=736).16
Preliminary evidence from several small studies is also indicative of impaired quality of life in adults with ADHD. In an Icelandic study of 369 university students (aged 18–53 years), a negative relationship was found between global life satisfaction, ADHD symptoms and associated problems, such as emotional and social functioning.17 In addition, two small US studies both found that having ADHD was associated with lower quality of life and productivity in students.18,21
What is the economic impact of ADHD?
ADHD can be an economic burden, and is associated with increased healthcare costs for people of all ages with the disorder, possibly reflecting use of social care, education resources, treatment and productivity loss by family members due to ADHD-related activities.22,23 Adults with ADHD may also experience a range of financial difficulties and have compulsive spending habits.4,9
The impact of ADHD on healthcare resource use
A major contributory factor to the societal burden of ADHD is the increased healthcare resource utilisation observed by individuals with ADHD. In the UK, estimated annual healthcare costs associated with the treatment of ADHD in adolescents have been reported as £670 million, with education and National Health Service (NHS) resources accounting for approximately 76% and 24% of spending, respectively. In 2010, this equated to a mean cost per adolescent for NHS, social care and education resources of £5493.22
An analysis of total national annual ADHD-related costs in Europe — using data from Belgium, Germany, Sweden and the UK and applying findings to the Netherlands (based on Dutch 2011 census data with cost estimates converted to Euros) — indicated that the total national annual ADHD-related costs for the Netherlands ranged from €1041–€1520 million. These costs related to education, productivity loss by family members due to ADHD-related activities of the child/adolescent, healthcare costs by family members, healthcare costs for children and adolescents, and social services costs (Figure 1).23
Figure 1: National estimated ADHD-related costs (millions) by cost categories in Europe, using the Netherlands as a reference case. Reproduced with permission from Le HH et al. Eur Child Adolesc Psychiatry 2014; 23: 587-598.23
The impact of ADHD on personal finances
UK results from the European Lifetime Impairment Survey (sponsored by Shire, now part of Takeda) found that adults with ADHD may experience a range of financial difficulties, such as9:
- Difficulty saving for retirement
- Poor credit rating or debt
- Buying on impulse
- Difficulty saving and managing finances.
Furthermore, results of a series of European and North American focus groups (sponsored by Shire, now part of Takeda) found that adults with ADHD reported problems with wasteful spending and compulsive shopping, as well as difficulty remembering to pay bills and how much money they had.4
Financial problems affecting parents of children with ADHD
There is some evidence that parents and carers of children with ADHD may experience financial difficulties, thus impacting the entire family:
- The European Caregiver Perspective on Pediatric ADHD study (sponsored by Shire, now part of Takeda), reported that 38% of carers (n=2872) had been late for work in the past month due to their child’s ADHD, and that 31% of carers (n=3688) had altered their employment status due to their child or adolescent’s ADHD.24
- A US study found that carers of children with ADHD had significantly higher absence days (8 vs 7; p<0.0001) and turnover (5% vs 4%; p<0.01) compared with carers of children without ADHD.25
What are the positives of having ADHD?
For some adults with ADHD, the disorder may not be perceived as wholly negative. As part of a series of European and North American focus groups (sponsored by Shire, now part of Takeda), 108 adults with ADHD were asked whether or not they would agree to their ADHD being “cured” or “taken away”, with 35% not agreeing. Many individuals indicated that aspects of their ADHD are important for their personality, e.g. creativity.4 A systematic review found potential links between ADHD and creativity that required further investigation. For example, adults with ADHD symptoms were found to have a higher rate of creative achievements in daily life than adults without ADHD.19
Many individuals report that aspects of their ADHD are important for their personality.4
Some adults with ADHD may be high functioning and may not present with a typical pattern of functional impairments in their daily life. In addition, some individuals may develop adaptive or compensatory skills to mask the overt behavioural problems associated with ADHD, and may find employment that is well suited to their symptom profile.26
- Biederman J, Faraone SV, Spencer TJ, et al. Functional impairments in adults with self-reports of diagnosed ADHD: a controlled study of 1001 adults in the community. J Clin Psychiatry 2006; 67: 524-540.
- Caci H, Doepfner M, Asherson P, et al. Daily life impairments associated with self-reported childhood/adolescent attention-deficit/hyperactivity disorder and experiences of diagnosis and treatment: results from the European Lifetime Impairment Survey. Eur Psychiatry 2014; 29: 316-323.
- Fredriksen M, Dahl AA, Martinsen EW, et al. Childhood and persistent ADHD symptoms associated with educational failure and long-term occupational disability in adult ADHD. Atten Defic Hyperact Disord 2014; 6: 87-99.
- Brod M, Pohlman B, Lasser R, et al. Comparison of the burden of illness for adults with ADHD across seven countries: a qualitative study. Health Qual Life Outcomes 2012; 10: 47.
- De Graaf R, Kessler RC, Fayyad J, et al. The prevalence and effects of adult attention-deficit/hyperactivity disorder (ADHD) on the performance of workers: results from the WHO World Mental Health Survey Initiative. Occup Environ Med 2008; 65: 835-842.
- Shifrin JG, Proctor BE, Prevatt FF. Work performance differences between college students with and without ADHD. J Atten Disord 2010; 13: 489-496.
- Halmøy A, Fasmer OB, Gillberg C, et al. Occupational outcome in adult ADHD: impact of symptom profile, comorbid psychiatric problems, and treatment: a cross-sectional study of 414 clinically diagnosed adult ADHD patients. J Atten Disord 2009; 13: 175-187.
- Cussen A, Sciberras E, Ukoumunne OC, et al. Relationship between symptoms of attention-deficit/hyperactivity disorder and family functioning: a community-based study. Eur J Pediatr 2012; 171: 271-280.
- Pitts M, Mangle L, Asherson P. Impairments, diagnosis and treatments associated with attention-deficit/hyperactivity disorder (ADHD) in UK adults: results from the lifetime impairment survey. Arch Psychiatr Nurs 2015; 29: 56-63.
- Humphreys KL, Lee SS. Risk taking and sensitivity to punishment in children with ADHD, ODD, ADHD+ODD, and controls. J Psychopathol Behav Assess 2011; 33: 299-307.
- Sørensen L, Sonuga-Barke E, Eichele H, et al. Suboptimal decision making by children with ADHD in the face of risk: poor risk adjustment and delay aversion rather than general proneness to taking risks. Neuropsychology 2017; 31: 119-128.
- American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. 2013.
- Adamou M, Arif M, Asherson P, et al. Occupational issues of adults with ADHD. BMC Psychiatry 2013; 13: 59.
- Barkley RA, Murphy KR, Dupaul GI, et al. Driving in young adults with attention deficit hyperactivity disorder: knowledge, performance, adverse outcomes, and the role of executive functioning. J Int Neuropsychol Soc 2002; 8: 655-672.
- Curry AE, Metzger KB, Pfeiffer MR, et al. Motor vehicle crash risk among adolescents and young adults with attention-deficit/hyperactivity disorder. JAMA Pediatr 2017; 171: 756-763.
- Caci H, Asherson P, Donfrancesco R, et al. Daily life impairments associated with childhood/adolescent attention-deficit/hyperactivity disorder as recalled by adults: results from the European Lifetime Impairment Survey. CNS Spectr 2015; 20: 112-121.
- Grenwald-Mayes G. Relationship between current quality of life and family of origin dynamics for college students with attention-deficit/hyperactivity disorder. J Atten Disord 2002; 5: 211-222.
- O’Callaghan P, Sharma D. Severity of symptoms and quality of life in medical students with ADHD. J Atten Disord 2014; 18: 654-658.
- Hoogman M, Stolte M, Baas M, et al. Creativity and ADHD: A review of behavioral studies, the effect of psychostimulants and neural underpinnings. Neurosci Biobehav Rev 2020; 119: 66-85.
- Young S, Bramham J, Gray K, et al. The experience of receiving a diagnosis and treatment of ADHD in adulthood: a qualitative study of clinically referred patients using interpretative phenomenological analysis. J Atten Disord 2008; 11: 493-503.
- Gudjonsson GH, Sigurdsson JF, Eyjolfsdottir GA, et al. The relationship between satisfaction with life, ADHD symptoms, and associated problems among university students. J Atten Disord 2009; 12: 507-515.
- Telford C, Green C, Logan S, et al. Estimating the costs of ongoing care for adolescents with attention-deficit hyperactivity disorder. Soc Psychiatry Psychiatr Epidemiol 2013; 48: 337-344.
- Le HH, Hodgkins P, Postma MJ, et al. Economic impact of childhood/adolescent ADHD in a European setting: the Netherlands as a reference case. Eur Child Adolesc Psychiatry 2014; 23: 587-598.
- Flood E, Gajria K, Sikirica V, et al. The Caregiver Perspective on Paediatric ADHD (CAPPA) survey: understanding sociodemographic and clinical characteristics, treatment use and impact of ADHD in Europe. J Affect Disord 2016; 200: 222-234.
- Kleinman NL, Durkin M, Melkonian A, et al. Incremental employee health benefit costs, absence days, and turnover among employees with ADHD and among employees with children with ADHD. J Occup Environ Med 2009; 51: 1247-1255.
- Kooij JJS, Bijlenga D, Salerno L, et al. Updated European Consensus Statement on diagnosis and treatment of adult ADHD. Eur Psychiatry 2019; 56: 14-34.